- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,677.35 / $13,182.57
| Facility | | $1,819.70 | $4,677.35 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $13,489.63 / $28,840.32
| Facility | | $4,466.84 | $13,489.63 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,677.35 / $12,589.25
| Facility | | $398.11 | $4,677.35 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | 22 | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $316.23 / $316.23 / $316.23
| Facility | AS | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |